Patients with thyroid cancer usually present with a thyroid mass with or without cervical adenopathy.[58,59,60,61] Younger age is associated with a more aggressive clinical presentation in differentiated thyroid carcinoma. Compared with adults, children have a higher proportion of nodal involvement (40%–90% vs. 20%–50%) and lung metastases (20%–30% vs. 2%).[56] Likewise, when compared to pubertal adolescents, prepubertal children have a more aggressive presentation with a greater degree of extrathyroid extension, lymph node involvement, and lung metastases. However, outcome is similar in the prepubertal and adolescent groups.[62]

Diagnostic evaluation

Initial evaluation of a child or adolescent with a thyroid nodule should include the following:

Tests of thyroid function are usually normal, but thyroglobulin can be elevated.

Fine-needle aspiration as an initial diagnostic approach is sensitive and useful. However, in doubtful cases, open biopsy or resection should be considered.[63,64,65,66,67] Open biopsy or resection may be preferable for young children as well.